Chlorhexidine Oral Care in Critically Ill Adults

Three systematic reviews and 2 randomized clinical trials were identified regarding the clinical effectiveness of chlorhexidine oral care in adult patients who were in critical care and being mechanically ventilated. The evidence was of limited quality, with methodological limitations. Compared to ozonated water and to Nanosil, chlorhexidine oral care was associated with a significantly higher risk of ventilator-associated pneumonia. Compared to bicarbonate, chlorhexidine oral care was associated with a significantly lower risk of ventilator-associated pneumonia. There was no significant difference in the risk of ventilator-associated pneumonia between chlorhexidine and other agents, such as potassium permanganate, hydrogen peroxide, or miswak. There was no significant difference in the risk of mortality between oral care with chlorhexidine and that with other oral care drugs. An evidence-based guideline targeting individuals who require assistance on oral care recommended a multi-component oral care protocol. No specific recommendation regarding the use of oral care agents for the prevention of ventilator-associated pneumonia was made because of lack of evidence. There is a lack of evidence on the safety or cost-effectiveness of chlorhexidine oral care in adults who are in critical care and being mechanically ventilated.

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Does oral care with chlorhexidine reduce ventilator-associated pneumonia in mechanically ventilated adults?

British Journal of Nursing ◽

10.12968/bjon.2019.28.11.682 ◽

2019 ◽

Vol 28 (11) ◽

pp. 682-689 ◽

Cited By ~ 2

Author(s):

Laura Jackson ◽

Melissa Owens

Keyword(s):

Critical Care ◽

Oral Cavity ◽

Critically Ill ◽

Oral Care ◽

Ventilator Associated Pneumonia ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

Oral colonisation by pathogens contributes to contracting ventilator-associated pneumonia (VAP). The aim of this review was to determine whether the use of the antiseptic chlorhexidine in the intra-oral cavity reduced its incidence in the critically ill, mechanically ventilated adult. The findings from this review led to the conclusion that chlorhexidine reduced the occurrence of VAP. Although a recommendation to implement the use of intra-oral chlorhexidine for mechanically-ventilated patients within critical care can be made, further exploration into required frequency and method of administration would be beneficial to reduce unnecessary exposure and hinder pathogenic resistance.

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Nurses’ Implementation of Guidelines for Ventilator-Associated Pneumonia From the Centers for Disease Control and Prevention

American Journal of Critical Care ◽

10.4037/ajcc2007.16.1.28 ◽

2007 ◽

Vol 16 (1) ◽

pp. 28-37 ◽

Cited By ~ 88

Author(s):

Carolyn L. Cason ◽

Tracy Tyner ◽

Sue Saunders ◽

Lisa Broome

Keyword(s):

Intensive Care ◽

Disease Control ◽

Intensive Care Units ◽

Oral Care ◽

The United States ◽

Hand Washing ◽

Ventilator Associated Pneumonia ◽

Care Protocol ◽

Control And Prevention ◽

Centers For Disease Control

• Background Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. • Objective To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. • Methods Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. • Results Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols. • Conclusions The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.

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EARLY PROBIOTICS IN PREVENTING VENTILATOR-ASSOCIATED PNEUMONIA AFTER MULTIPLE TRAUMA

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i10.38114 ◽

2020 ◽

pp. 83-85

Author(s):

TAMER HABIB ◽

AMIRA B KASSEM ◽

ISLAM AHMED

Keyword(s):

Multiple Trauma ◽

University Hospital ◽

Control Group ◽

Trauma Patients ◽

Ventilator Associated Pneumonia ◽

Mechanically Ventilated ◽

Significant Difference ◽

Multiple Trauma Patients ◽

And Control

Objective: Using probiotics in preventing ventilator-associated pneumonia (VAP) remain controversial due to different intensive care unit (ICU) populations included in such studies. The aim of this study is to evaluate the role of probiotics in prophylaxis of VAP after multiple trauma. Methods: Sixty-five adult multiple trauma patients on mechanical ventilator (expected ≥48 h) after admission to the Critical Care Medicine Department, Alexandria Main University Hospital from June to November 2018. Patients were randomly assigned using computer sheet into two groups; probiotics group (32 patients received one Lacteol Forte® sachet through orogastric/nasogastric tube 3 times daily during their ICU stay) and control group (33 patients received similar regimen of placebo sachets). All patients were followed up and subjected to all possible strategies of the diagnosis of microbiologically confirmed VAP. Results: Sixty-five patients were enrolled with a mean of age (39.48±7.692) years, 80% of them were male. Regarding the incidence of VAP, it was 18.46% of all patients without statistically significant difference between probiotics group (15.63%) and control group (21.21%) (p=0.751). Conclusion: Routine use of early probiotics in mechanically ventilated multiple trauma patients was not associated with lower incidence of VAP, duration of MV, or ICU mortality.

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Compliance among critical care nurses with performing oral care protocols for mechanically ventilated patients

Journal of Microbiology Immunology and Infection ◽

10.1016/j.jmii.2015.02.479 ◽

2015 ◽

Vol 48 (2) ◽

pp. S136-S137

Author(s):

Hsin-Lan Lin

Keyword(s):

Critical Care ◽

Oral Care ◽

Critical Care Nurses ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

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Probiotics for Disease Prevention: A Focus on Ventilator-Associated Pneumonia

Annals of Pharmacotherapy ◽

10.1345/aph.1q241 ◽

2011 ◽

Vol 45 (11) ◽

pp. 1425-1432 ◽

Cited By ~ 4

Author(s):

Jennifer L Bailey ◽

Siu Yan Yeung

Keyword(s):

Antimicrobial Agents ◽

Future Research ◽

Published Data ◽

Ventilator Associated Pneumonia ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Patient Disposition ◽

Significant Difference ◽

Colonization Rates ◽

Ventilated Patients

Objective: To summarize published data regarding the safety and efficacy of probiotics in the prevention of ventilator-associated pneumonia (VAP). Data Sources: PubMed databases (January 2000-August 2011) were searched and a bibliographic review of published articles was performed to identify original reports of probiotic administration for the prevention of VAP using the search terms probiotics, synbiotics, and ventilator-associated pneumonia. Study Selection and Data Extraction: Two pilot studies, 2 randomized controlled trials (RCTs), and 1 meta-analysis have addressed probiotic use for VAP prevention and were included in the review. Data Synthesis: VAP frequently occurs in mechanically ventilated patients. Given the lack of new antimicrobial agents, probiotics have been studied for their ability to modify human microflora colonization. Two studies examining pathogen colonization rates favored probiotics, with reduced incidence and increased duration until the emergence of new species. One prospective RCT found significant reduction in the incidence of VAP and colonization rates, but no significant difference in patient disposition outcomes. Another RCT examining 28-day mortality found no overall benefit with probiotic use and no reduction in colonization rates. Conclusions: Clinical trials have failed to demonstrate a consistent beneficial effect of probiotics in mechanically ventilated patients; thus, they are not recommended for routine clinical use. However, heterogeneity among study designs may hinder this assessment and the designs should be unified in future research.

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Using Evidence-Based Practice to Prevent Ventilator-Associated Pneumonia

Critical Care Nurse ◽

10.4037/ccn2012964 ◽

2012 ◽

Vol 32 (4) ◽

pp. 41-51 ◽

Cited By ~ 24

Author(s):

Mary Beth Sedwick ◽

Mary Lance-Smith ◽

Sara J. Reeder ◽

Jessica Nardi

Keyword(s):

Interdisciplinary Collaboration ◽

Compliance Rate ◽

Oral Care ◽

Feedback System ◽

Ventilator Associated Pneumonia ◽

Strict Adherence ◽

Ulcer Disease ◽

Vein Thrombosis ◽

Care Protocol ◽

Healthcare Improvement

BackgroundStrategies are needed to help prevent ventilator-associated pneumonia.ObjectiveTo develop a ventilator bundle and care practices for nurses in critical care units to reduce the rate of ventilator-associated pneumonia.MethodThe ventilator bundle developed by the Institute for Healthcare Improvement was expanded to include protocols for mouth care and hand washing, head-of-bed alarms, subglottic suctioning, and use of an electronic compliance feedback tool. Compliance audits were used to provide immediate electronic feedback.ResultsAdherence to practices included in the bundle increased. Compliance rates were greater than 98% for prophylaxis for peptic ulcer disease and deep-vein thrombosis, interruption of sedation, and elevation of the head of the bed. The compliance rate for the oral care protocol increased from 76% to 96.8%. Readiness for extubation reached at least 92.4%. Rates of ventilator-associated pneumonia decreased from 9.47 to 1.9 cases per 1000 ventilator days. The decrease in rates produced an estimated savings of approximately $1.5 million.ConclusionStrict adherence to bundled practices for preventing ventilator-associated pneumonia, enhanced accountability for initiating protocols, use of a feedback system, and interdisciplinary collaboration improved patients’ outcomes and produced marked savings in costs.

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The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit

Journal of Intensive Care Medicine ◽

10.1177/0885066608326972 ◽

2008 ◽

Vol 24 (1) ◽

pp. 54-62 ◽

Cited By ~ 52

Author(s):

Carrie S. Sona ◽

Jeanne E. Zack ◽

Marilyn E. Schallom ◽

Maryellen McSweeney ◽

Kathleen McMullen ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Low Cost ◽

Oral Care ◽

Surgical Intensive Care Unit ◽

Ventilator Associated Pneumonia ◽

Surgical Intensive Care ◽

Care Protocol ◽

The Impact

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Knowledge, attitude and oral care practices for preventing ventilator-associated pneumonia among critical care nurses – A questionnaire study

Indian Journal of Dental Research ◽

10.4103/ijdr.ijdr_611_16 ◽

2020 ◽

Vol 31 (3) ◽

pp. 426

Author(s):

Ashita Uppoor ◽

Yamini Mannava ◽

SangeetaUmesh Nayak ◽

Dilip Naik ◽

Abhiram Maddi

Keyword(s):

Critical Care ◽

Oral Care ◽

Critical Care Nurses ◽

Questionnaire Study ◽

Ventilator Associated Pneumonia ◽

Care Practices

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Biofilm formation on three different endotracheal tubes: A prospective clinical trial

10.21203/rs.3.rs-17258/v4 ◽

2020 ◽

Author(s):

Hulda Rosa Thorarinsdottir ◽

Thomas Kander ◽

Anna Holmberg ◽

Sarunas Petronis ◽

Bengt Klarin

Keyword(s):

Noble Metal ◽

Biofilm Formation ◽

Noble Metals ◽

Ventilator Associated Pneumonia ◽

High Grade ◽

Invasive Ventilation ◽

Mechanically Ventilated ◽

Endotracheal Tubes ◽

Frequent Event ◽

Significant Difference

Abstract Background: Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The biofilm is believed to act as a reservoir for infecting microorganisms and thereby contribute to development and relapses of ventilator-associated pneumonia (VAP). Once a biofilm has formed on an ETT surface, it is difficult to eradicate. This clinical study aimed to compare biofilm formation on three widely used ETTs with different surface properties and to explore factors potentially predictive of biofilm formation.Methods: We compared the grade of biofilm formation on ETTs made of uncoated polyvinyl chloride (PVC), silicone-coated PVC, and PVC coated with noble metals after > 24 hours of mechanical ventilation in critically ill patients. The comparison was based on scanning electron microscopy of ETT surfaces, biofilm grading, surveillance and biofilm cultures, and occurrence of VAP.Results: High-grade (score ≥ 7) biofilm formation on the ETTs was associated with development of VAP (OR 4.17 [95% CI 1.14–15.3], p = 0.031). Compared to uncoated PVC ETTs, the silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation (OR 0.18 [95% CI 0.06–0.59], p = 0.005, and OR 0.34 [95% CI 0.13–0.93], p = 0.036, respectively). No significant difference was observed between silicon-coated ETTs and noble-metal-coated ETTs (OR 0.54 [95% CI 0.17–1.65], p = 0.278). In 60% of the oropharyngeal cultures and 58% of the endotracheal cultures collected at intubation, the same microorganism was found in the ETT biofilm at extubation. In patients who developed VAP, the causative microbe remained in the biofilm in 56% of cases, despite appropriate antibiotic therapy. High-grade biofilm formation on ETTs was not predicted by either colonization with common VAP pathogens in surveillance cultures or duration of invasive ventilation.Conclusion: High-grade biofilm formation on ETTs was associated with development of VAP. Compared to the uncoated PVC ETTs, the silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation. Further research on methods to prevent, monitor, and manage biofilm occurrence is needed.Trial registration: ClinicalTrials.gov, NCT02284438. Retrospectively registered on 21 October 2014, URL: https://clinicaltrials.gov/ct2/show/NCT02284438.

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